PowerPoint Presentation

Smoking Cessation

Kevin Scott Ferentz, MD

Associate Professor

Department of Family Medicine

Univ. of Maryland School of Medicine

Cigarette smoking is the single most important cause of disease and

premature death in the United States

Cigarette smoking is the single most important cause of disease and

premature death in the United States

Health Effects of Smoking Heart disease Lung disease – COPD, asthma Cancer

– Lung, ENT, pancreas– Cervix, colorectal– Skin (squamous cell)

Vascular disease - impotence Stroke Cataracts Gum disease Dementia Early menopause

Osteoporosis Wound healing Anxiety Miscarriage SIDS Hearing loss Rheumatoid arthritis Macular degeneration Tooth decay Depression Multiple sclerosis

Smoking in the U.S.Smoking in the U.S.

25% of adults men = women rate hasn’t dropped in 1990’s 1.3 million quit each year 3,000 teens start each day

adolescent smoking increasing more ex-smokers than current smokers

Involuntary smoking is a cause of disease in

non-smokers

Involuntary smoking is a cause of disease in

non-smokers

Smoking kills more people each year than

alcohol cocaine crack heroin

homicide suicide car accidents fires AIDS

C O M B I N ED!!!

What’s in a cigarette?

4,000 chemicals tar carbon monoxide nicotine

Health benefits after quitting

cough, DOE resolve in weeks exercise tolerance improves rapidly bladder cancer: 50% reduction in 5 years lung cancer: 50% reduction in 10 years heart disease: 50% reduction in 1 year! No excess risk of heart disease by 10-15 years vascular disease: 50% reduction in 5 years mortality - same as never smokers by 10-15 yrs

Non-health reasons for quittingNon-health reasons for quitting

COST!!! inconvenience self-esteem role model

Common concernsCommon concerns Withdrawal

short lived Cravings

last 3-5 minutes, diminish rapidly Tension

validate, normalize find other ways to cope

Weight gain - not inevitable! 1/3 gain: 5-8 lbs.

Three Aspects of Addiction

Physical Psychological Behavioral

Behavior modification

review reasons for quitting (index card) identify triggers (4 day diary) plans to avoid or cope with each trigger change habit: packs only, different brands develop support system (tell everyone) self rewards (day, week, month, year) written commitment to quit day

Pharmacological treatment

nicotine replacement - “methadone for the smoker” gum patches nasal spray inhaler

bupropion all decrease cravings, withdrawal 20-25% quit rates at 1 year

Nicotine replacement and buproprion should always

be used in conjunction with behavior modification

Conclusions

We haven’t started winning the war All smoking patients should be

counseled Always use pharmacological

interventions Be public health advocates